The other day a mother brought in her 10-year-old child, and from the minute she walked through the door she emphatically insisted on a flu test. She told the physician that she was adamant about getting a flu test for her child. She was then politely informed that no flu tests were in stock at the moment. Stricken with worry regarding her child’s well-being, the mother proceeded to get angry. The physician calmed the worried mother then promptly asked what symptoms her child was experiencing that made her feel a flu test was needed. Discussion with the mother revealed that child had NO fever, NO body aches, NO runny nose, NO headache, NO fatigue, NO sore throat, or any other of the symptoms normally associated with the flu. The physician then asked what symptoms the child was experiencing that caused the mother such worry…The mother replied, “He has a tummy ache.” The doctor continued with a thorough examination and determined the child showed signs of acute appendicitis. The physician instructed the mother to take her child immediately to the ER where the diagnosis was confirmed and the proper treatment could be given.
Why I am telling this story? This anecdote illustrates another reason why the flu test is not as valuable of a test as other tools physicians have at their disposal including a proper and thorough physical examination. In fact, the flu test is not a necessary test in the diagnosis of the flu. It often can lead to more problems than conclusions and almost never changes the treatment plan. It will sometimes even be a distraction from other possible diagnoses that could warrant immediate attention such as the case above or other scenarios where a patient might have pneumonia or a kidney infection or strep throat. More importantly, the flu test is only about 50% accurate at determining whether or not a patient has the flu! Yes, it is like flipping a coin and, furthermore, it will not change the course of a skilled physician’s treatment despite a positive or negative reading. Clinical assessment of whether or not you have the flu based on symptoms and a proper exam is still more accurate than the flu test.
Since we are talking about the flu, many people ask for a medication known as Tamiflu to help with their symptoms. Which is understandable given most have been led to believe that Tamiflu will help them feel better more quickly. But according to the CDC and most Physician Academies, Tamiflu is not recommended for treatment of the flu in healthy children and adults. It has a small window of opportunity to be effective which most people are out of before they present to the clinic. Although some research states giving Tamiflu within 48 hours of the onset of symptoms will shorten the overall time of those symptoms by less than one day, in reality, it’s most effective when used within the first 24 hours of onset. Early antiviral treatment can shorten the duration of fever and illness symptoms by most one day and MAY reduce the risk of complications from influenza (e.g. otitis media in young children, pneumonia, and respiratory failure). BUT side effects of Tamiflu such as nausea, vomiting, and headache are quite common. And let us not forget, Tamiflu is very expensive and most insurances do not cover it.
Tamiflu is recommended in specific clinical situations. These are:
- children aged younger than 2 years;1
- adults aged 65 years and older;
- persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), and metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions (including disorders of the brain, spinal cord, peripheral nerve, and muscle, such as cerebral palsy, epilepsy [seizure disorders], stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, or spinal cord injury)
- persons with immunosuppression, including that caused by medications or by HIV infection;
- women who are pregnant or postpartum (within 2 weeks after delivery);
- persons aged younger than 19 years who are receiving long-term aspirin therapy;
- American Indians/Alaska Natives;
- persons who are extremely obese (i.e., body mass index is equal to or greater than 40); and
- Residents of nursing homes and other chronic care facilities.
When it comes to making a diagnosis of Influenza (“the flu”), flu tests are not a good idea overall. Trusting the physician to make a good clinical judgment is the best advice I could give. Secondly, in the treatment of the flu the tried and true remedies such as Tylenol, Motrin, drinking lots of fluids such as sports drinks and Juices, Vitamin C, chicken soup, and rest still work well without added side effects of largely ineffective medicines like Tamiflu. Be seen by your doctor to verify there is nothing else wrong with you and to evaluate for complications of the flu. Remember, the best idea when it comes to the flu is prevention via the flu vaccine which is both effective and affordable.